In recent years, several studies have reported on an improvement in the visualization and classification of lesions in the upper and lower gastrointestinal tract using computed virtual chromoendoscopy (CVC), such as narrow-band imaging (NBI), flexible spectral imaging color inhancement (FICE) or i-Scan. CVC enhances the contrast of the mucosal surface without the use of dyes. The FICE system is based on narrowing of the bandwidth of the conventional endoscopic image arithmetically by a spectral estimation technology and enhances the vascular network as well as the pit pattern, facilitating the assessment of gastrointestinal mucosal lesions [2]. Neumann et al. described for the first time the use of double-balloon enteroscopy (DBE) and the FICE system for classification of small-bowel lesions in a case series [3]. FICE was found to be a helpful method for the evaluation of adenomatous small-bowel polyps and angiodysplasias [3].

The retrospective trial by Imagawa et al. investigated the value of the FICE system for detection of small-bowel lesions using video capsule endoscopy (PillCam SB1; Given Imaging Ltd., Yokneam, Israel) for evaluation of the small bowel [1]. For this new technique the FICE software was installed in the video capsule workstation (CE-FICE). The FICE images were compared with the conventional capsule images by five physicians, using 145 lesions from 122 patients who underwent capsule endoscopy for suspected small-bowel disease. The main indication was suspected mid-gastrointestinal bleeding. The analysis of the images was carried out with Rapid Reader 6 software. Three FICE settings were evaluated. The authors found an improved image quality for angiodysplasias (87 %), erosions and ulcerations (53 %), and tumors (25 %) for FICE setting 1 and similar results for FICE setting 2. They therefore concluded that the CE-FICE system improves the visibility of these small-bowel lesions.

These findings confirm the results of a pilot study of 10 consecutive patients, which was conducted by our working group and published in 2010 [4]. Pohl et al. demonstrated that FICE technology could facilitate the detection of lesions that had a tendency to bleed. However, the number of non-relevant lesions detected using this technology also increased. In contrast to these latter two studies, Gupta et al. found that it was mainly the detection of non-pathological lesions that was improved, and that there was only a slight advantage for detection of vascular lesions [5]. One reason might be the use of different PillCam devices. The PillCam SB1 device was used in the study by Imagawa et al., whereas Gupta et al. used the PillCam SB2 device, which is equipped with better technology and provides higher white light image quality. As has already been shown for Barrett’s esophagus and colon polyps, CVC cannot increase the detection rate of lesions, but does help to classify them. This might be different in the small bowel due to different indications. It seems that the best results from CE-FICE can be achieved in bleeding lesions, which are the main indication for evaluation of the small bowel. Multicenter trials are necessary to clarify the real value of the CE-FICE and to determine the best indications for this modality.